Assume a vendor finger-stick test that you get at your company’s “health fair” is 96 percent accurate. Further assume that vendors are seeking silent disorders that on average have a 1 percent prevalence. Do you suppose your odds of a false positive in those circumstances are 4 percent? To use a technical clinical term, nope. Out of 100 employees, the single employee who is actually afflicted with this disorder should test positive.

Unfortunately, 4 of the other 99 will also test positive even though they are fine…because a 96%-accurate test is also 4%-inaccurate. This means of the 5 people who test positive, only 1 has the disorder — a false positive rate of 80 percent!

…Those false-positives make overdiagnosis (finding and treating maladies that don’t exist) the rule, not the exception. Nonetheless, a lexicographer would say overdiagnosis doesn’t even begin to describe the likely result of these companywide disease treasure hunts, because overdiagnosis is merely the inadvertent occasional side effect of good faith efforts by doctors to help patients. So we need a new word to describe what goes on in wellness: hyperdiagnosis…

The poster-child example of hyperdiagnosis? Nebraska’s Koop Award-winning wellness programfor state employees. To win the Koop Award, the state ended up informing fully 40 percent of people who agreed to be screened — and remember, people who volunteer to be screened to save money on insurance will likely be the healthier segment — that they had some kind of cardiometabolic condition.

Somehow almost none of those 40 percent ended up doing anything about their condition…and yet, they lived to tell the tale. Also, the perpetrators claimed large savings simply by finding all this illness even though they didn’t do anything about it.

Comments (12)

“…overdiagnosis is merely the inadvertent occasional side effect of good faith efforts by doctors to help patients.”

With every major workplace having wellness programs for their employees, I am sure we will soon be seeing problems with companies trying to prevent this overdiagnosis. Every corporation diagnosing their employees at a 4% false positive rate is a major issue.

That’s an interesting analysis, which hopefully will encourage health plans to design better wellness programs. In research test and retest are standard mantras. Surely retesting the five people would quickly identify the single individual who actually has the condition.